Cocaine use by pregnant women has increased dramatically over the past decade, with resultant concern over the long-term negative effects of cocaine exposure on the outcome of the developing infant. Maternal use of cocaine is also associated with numerous other risk conditions which can negatively affect infant outcome, such as increased risk for child abuse/neglect, increased maternal psychological symptoms, and altered care-giving behavior. In addition to documenting a range of infant outcome measures, the proposed study aims to assess environmental and maternal psychological factors in cocaine-exposed mother-infant pairs. The proposed study will be a longitudinal, prospective investigation of the medical, environmental, and developmental correlates of cocaine exposure during the first two years of life. Four-hundred infants (200 cocaine-exposed; 200 non-exposed) and mothers will be followed from birth to two years of age, and given standardized assessments of developmental and physical outcome. Cocaine infants will be randomly selected; control infants will be drawn from the same race/social class population as cocaine infants, matched for maternal age, infant prematurity, and very low birth weight (VLBW) status. At intake, demographic, medical, and substance abuse history data will be taken from chart review and clinical interview. Standardized questionnaires assessing maternal psychological status, coping style, social supports, intellectual ability, and exposure to violence will be given. Infants and mothers will be seen at 40 weeks (gestational age), 6-1/2, 12, 18, and 24 months (ages corrected for prematurity). Infant environmental risk, including abuse/neglect, growth failure, and out of home placement, will be documented throughout. Data will be evaluated descriptively as well as through a series of multivariate analyses of variance (with repeated measures) to describe the functioning of cocaine-exposed infants, as well as the relationship of cocaine and other substances to infant outcome, maternal psychological functioning, and environmental risk. The proposed research will provide information about infant developmental sequelae, maternal psychological status, and caregiving behaviors which can guide the design of effective maternal drug treatment and infant intervention programs.